An Introduction to Red Flags in Serious Pathology
Only around 1% of all musculoskeletal presentations in primary care will be be due to serious pathology.[1] Such pathologies include spinal infection, cauda equina, fracture, malignancy and spondyloarthropathies.
Yet despite the low incidence rates, these conditions should be considered as differential diagnoses when individuals present with back pain - particularly if the patient is not responding in an expected way or is starting to worsen.[1] Identifying serious pathology early on is very important for a number of reasons:
- Prognosis improves with early diagnosis
- Patients tolerate treatment better.
- Outcomes are better
- Quality of life is better maintained[1]
However, it can be challenging identifying serious pathologies as they often masquerade as musculoskeletal conditions, particularly in the early stages of disease. As a disease progresses, it becomes easier to identify as patients become systemically unwell.[1]
What are Red Flags?[edit | edit source]
Red flag screening questions were developed to help detect serious spine pathology.[1] However, specific red flag questions are not used consistently across guidelines and their is little evidence to support their use.[2][3] Moreover, there are 163 different items that could be considered to be red flags, all of which are subject to interpretation.[4] Because of these factors, the benefit of using red flags has been questioned.[4] Yet a clinician still needs to determine if a patient’s presenting condition is suitable for conservative management or if a referral is necessary. Thus, despite a lack of consensus, red flags are still considered the most reliable clinical indicator of potential serious pathology.[4]
- ↑ 1.0 1.1 1.2 1.3 1.4 Finucane L. An Introduction to Red Flags in Serious Pathology. Physioplus 2020.
- ↑ Premkumar A, Godfrey W, Gottschalk MB, Boden SD. Red Flags for Low Back Pain Are Not Always Really Red. J Bone Jt Surg. 2018;100(5):368–74.
- ↑ Cook CE, George S Z, Reiman M P. Red flag screening for low back pain: nothing to see here, move along: a narrative review. British Journal of Sports Medicine. 2018;52: 493–496.
- ↑ 4.0 4.1 4.2 Yusuf M, Finucane L, Selfe J. Red flags for the early detection of spinal infection in low back pain. BMC Musculoskeletal Disorders. 2019; 20(606). Available at: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-019-2949-6
